How This Dental Crown Case Was Paid By Medical Insurance
- February 2, 2021
- Laurie Owens CPC, CPB
- Medical Billing
- 3 Comments
Share This Post:
- Case Type: Dental Crown
- State: Florida
- Insurance Payer: Tricare
- Insurance Paid: $2,410.00
In this example Imagn Billing case you will see how a dental office in Florida successfully billed for dental crowns. Our Imagn Billing team processed this claim on 12/4/2020 to Tricare insurance and it was paid on 1/22/2021.
The 56-year-old female patient presented for additional treatment following chemotherapy and radiation. She was referred by the Mayo Clinic and pre-authorization was obtained.
Proving Medical Necessity
As noted in the provider’s SOAP note below:
- Squamous cell carcinoma of tongue
- Chemo & radiation 12/13/07
- Medical induced Xerostomia
- Noted necessity for crowns, removal of caries lesions, srp
CLINICAL SOAP NOTE
-Thursday, December 03, 2020 at 12:10:05 PM
Pt presents for Crown: # 29,30
RMH. No changes
Xrays:
Age of Previous Crown: initial placement
Dx: previous treated RCT
Tx: crowns #29,30
Treatment was reviewed with the patient.
Verbal and written consent obtained.
Topical anesthetic: benzocaine
Local anesthetic: Negative aspiration. infiltration with 1.8cc 2% lidocaine 1:100;000epi
Isolation: cotton rolls
Decay: moderate
Decay removed and tooth prepped for porcelain crown.
Buildup done:
HS GL Desensitizer, Prime and Bond Elect, Fluorocore 2
Prep finalized. Retraction cord packed with viscostat for 2 minutes. Retraction cord
removed.
Impression taken with Itero scanner.
Provisional fabricated with TempSpan A2 and cemented using HS Temp Cement.
Excess cement removed. Flossed.
Case sent to Glidewell.
Please fabricate full contour zirconium crown.
Shade: 2M2
Patient tolerated procedure well.
POIG, including warnings about postop sensitivity (hot/cold/pressure sensitivity and
possibility of endo). Explained to patient to be careful when flossing in the area around
the temporary and to avoid sticky foods. In the event the provisional comes out, pt
advised to call the office.
NV: Deliver crown/ IMP for partial (cu-sil)
Dr. John/ Pratt
Billing Medical Insurance
The practice collected all required documentation and clinical SOAP notes. After completing the verification of benefits(link), it was determined that coverage was available after co-insurance is satisfied. Pre-Authorization was obtained with an allowance of 6 visits to be completed by 4/30/2021.
- Allowable: $2,410.00
- Total Collected From Patient & Insurance: $2,410.00
- Applied to Deductible: $0
- Co-insurance: $31
- Patient Portion: $31
| Procedure | Diagnosis | Charged | Paid |
|---|---|---|---|
| 41899/D2740 | T45.1X5A; K11.7; Z85.810 | $2,410.00 | $2,379.00 |
Dental Comparison
| Procedure | Charges | Practice Write-off | Patient Portion |
|---|---|---|---|
| N/A | $2,410.00 | 38% | $910 |
Without medical insurance contribution, the practice would be writing off approximately 38% and using the annual $1500.00 maximum. Medical insurance saved the patient and the practice approximately $2000, whereas dental insurance would have been exhausted. If there are any other issues, the provider has the authorization to move forward until 4/30/21
Share This Post:
Laurie Owens CPC, CPB
As the Director of Medical Billing Education for Devdent Laurie brings over a decade of experience educating dental practices on billing medical insurance and the techniques to get claims paid. Laurie believes that patients should be able to utilize their medical insurance for procedures due to oral systemic conditions.
All Posts
Search
Subscribe to Newsletter
Online Education
Recent Posts
OSA Device Modifier Corrections Success Story
Devdent
May 19, 2023
Oral Cyst Excision Success Story
Devdent
May 19, 2023
OSA Billed to Medical Insurance Saving Patient’s Dental Benefits!
Devdent
May 19, 2023
$0 Out of Pocket Custom Fabricated Orthotic Device Success Story!
Devdent
May 19, 2023
Custom Airvata Device Success Story
Devdent
May 19, 2023
Recent Webinars
What Every Dentist Needs to Know About Medicare
Devdent
April 14, 2022
Don’t Get Caught On The Wrong Side
Laurie Owens CPC, CPB
March 28, 2022
Increase Case Acceptance with Medical Billing
Crystal May
March 17, 2022
Medical Billing and Coding for Implants and Oral Surgery
Devdent
March 7, 2022
Medical billing tips for pediatric and orthodontic practices
Devdent
October 27, 2021
Services
Medical Billing Software & Service
Learn how our team can help your practice save time on your medical claims.
Exclusive
Sleep Screening & Billing Software
Streamline dental sleep in your practice with custom pipelines and patient mode.
Exclusive
Dental Sleep’s Only At-Home Screening App
A simple, efficient, and consistent method for identifying and testing patients who have a high probability of OSA.
Exclusive
3 thoughts on “How This Dental Crown Case Was Paid By Medical Insurance”
Laurie, thank you for this article. I am attempting to search for resources for how to successfully code her medical insurance for my 23 year old granddaughter’s extensive dental needs. We have received a treatment plan to have all of her teeth crowned. The total cost is 47460. This treatment plan appears to be the consensus of three dentists. Emily had a bone marrow transplant in 2015. She was hospitalized for 16 months in three separate hospitals. During her hospitalization she had many complications, including the need for open heart surgery, acute respiratory distress and a week on ECMO. When she came home on a ventilator and 52 meds per day. All her teeth had cavities. We dealt with that, cost was 10,000. But the teeth under her repairs continued to deteriorate, due in part to acid reflux. Emily needs a hip replacement and due to Covid has waited a year for surgery. But she can not have surgery until her dental issues are addressed due to ongoing infection. The prosthodontist we have selected has no knowledge of how to code for dental work in Emily’s situation. So I am looking for information, and perhaps a person willing to consult with his office. Given the past 6 years, our financial situation does not allow us to meet this financial challenge alone. Again, thanks for the information.
Hello Ms. Jacobsen, that is horrible! My first question is what insurance does she have…HMO, PPO, EPO? The first thing I would want is a letter from her physician to correlate her medical condition with her oral cavity. From there you would need to contact her medical insurance for preauthorization of the treatment plan. Unless her prosthodontist is open to learning medical billing, you or your granddaughter would need to advocate for the benefit.
Hi Laurie,
I’m an RN who experienced an unfortunate accident while in Spain last November and was seen in the ER. I saw a dentist the next morning due to the ER not doing their due diligence and prolonged the vital teeth saving treatment I needed. I fractured 2 teeth and avulsed 1. I have been trying to get my medical insurance to pay for all dental and endodontist visits due to the nature of the injury and medical necessity. They’ve denied all claims due to “incorrect procedure codes” being used. Is there a way I can convert all of the CDT codes to CPT codes? They will accept a resubmission with CPT codes. Thanks in advance!